Medicaid Accountable Entities Program Update March, 2018 1 Health - - PowerPoint PPT Presentation

Medicaid Accountable Entities Program Update

March, 2018

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Health System Transformation Program (HSTP)

Community College of Rhode Island University of Rhode Island Rhode Island College

EOHHS

Transitional Program for Hospitals & Nursing Facilities

Reinventing Medicaid Phase II: Accountable Entities

Health Workforce Partnerships

Health System Transformation Project (HSTP)

System Transformation, including capacity building toward mature, broad based AEs and new specialized provider partnerships

Development of a healthcare workforce that is aligned with the goals of Health System Transformation and the Governor’s Jobs Plan One-year transitional funding to support the transition to new Accountable Entity structures.

Partnership with Institutions of Higher Education (DSHP)

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Medicaid Accountable Entities: Goals

❖ Substantially transition away from fee-for-service models ❖ Define Medicaid-wide population health targets (consistent with SIM), and link any incentive payments to performance ❖ Deliver coordinated, accountable care for all, with targeted support for high-cost/high-need populations ❖ Shift Medicaid expenditures from high-cost institutional settings to community-based settings as appropriate

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Medicaid Accountable Entities: Approach

• 2. Payment
• 1. Certification

Define expectations for Accountable Entities: capacity, structure, processes

• 2. Payment

Require transition from fee based to value based payment model (APM Requirements)

• 3. Incentives

Targeted Financial incentives to encourage/support for Infrastructure Development (HSTP)

Program Approach: Three Legged Stool

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Medicaid Accountable Entities: Opportunity

✓ Target: high/rising risk population Top 6% of Medicaid users accounting for 65% of cost, especially: Populations receiving institutional and residential services Populations with integrated physical and behavioral health care needs ✓ Alignment of financial incentives (State, MCO, AE) Shared responsibility for reduced cost, increased quality ✓ Transition to risk Using HSTP incentives to encourage/require increased AE financial risk and responsibility

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Progress to Date

88,240 142,947

20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17

AE Pilot Program Attributed Lives*

The AE Program has grown considerably since inception; first year financial performance is encouraging

$0.00 $0.00 $0.00 $0.39 $5.88 $10.12 $10.18

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PMPM AE Savings per Contract SFY 2017*

Source Data: MCO Shared Savings Reports *Note: UHC Shared Savings results are reported for the period July 2016 – September 2017 Source Data: AE Attributed Lives: MCO Quarterly Attributed Lives Snapshot Reports Medicaid Managed Care Enrollment: Q3 2017, RI Medicaid Monthly Managed Care Report as of 9/30/17 (Aug, Sept. Average) *Participating AEs include: Blackstone Valley Community Health Center, CHC ACO, Integra, Prospect CharterCARE, & Providence Community Health Center

First year financial performance is encouraging, as 4 of 7 AE contracts accomplished shared savings in SFY 17. As of Q3 2017 over half (51%) of managed care enrollment is now attributed to AEs.

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Key Challenges

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Partnership: CMS, State, MCO, AE

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Flexibility and innovation vs. standardization

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State budget & administrative resources

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Sustainability

Sustainability

❖ AE Operations Building, maintaining new provider capacity and infrastructure ❖ AE Incentives Interim support for AE Operations ❖ Shared Savings Source of ongoing funding to support AE operations

Incentive funding provides unique opportunity for startup funds to support investments in critical AE capacity and infrastructure…. ….Sustainability depends upon AE Savings replacing AE Incentives as source of funding

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Interagency Alignment

Deliver coordinated, accountable care for all, with targeted support for high- cost/high-need populations

goals priorities strategies levers

 High cost/high need populations (all)  Population Differences  Benefit Differences ✓ ALIGNED ✓ MOSTLY ALIGNED ✓ ALIGNED ✓ SOME DIFFERENCES  Alternative Payment Models (APMs)  Enhanced Provider Capacity  Statewide Metrics  Set Targets & Metrics (all)  APMs: Payor vs. Regulator  How to enhance provider capacity

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Backup: Targeted Financial Incentives: HSTP

Permissible HSTP Expenditures Details of Expenditures ”Attributable to Establishment of AEs” ❖ Incentive based infrastructure funding to AEs ❖ Health Workforce Development ❖ HSTP design, implementation and evaluation ❖ Vital State Health Programs

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Questions and Comments

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